FY 2017 ACL Congressional Justification

290 Pages·2016·2.02 MB·English

by  Greg Pugh

DEPARTMENT
of HEALTH
and HUMAN
SERVICES

Fiscal Year
2017

Administration for
Community Living

Justification of
Estimates for
Appropriations Committee
Back cover intentionally left blank.
DEPARTMENT OF HEALTH & HUMAN SERVICES Administration for Community Living

Washington, DC 20201

I am pleased to present the Administration for Community Living’s (ACL) FY 2017 President’s Budget
request, totaling $2.0 billion, a net increase of +$28 million. The vast majority of ACL’s funding is allocated
for grants that provide direct services and supports. ACL received modest increases in FY 2016 for many of
these core services programs and our FY 2017 request maintains these increases while also requesting
additional funding for three key areas. First, +$23.8 million is requested for nutrition and supportive
services programs to help meet the needs of a growing senior population— and thereby reduce or delay the
need for more expensive medical interventions and institutional services. Second, +$2 million is requested
for Elder Justice/Adult Protective Services (APS). Historically, an absence of federal stewardship in APS
has led to inconsistent data systems and no reporting requirements at the national level, and prevented APS
programs from conducting meaningful program evaluations. The additional funding will further support
states by providing significant, on-going technical assistance and resources for identifying promising and
best practices, participating in national APS data collection efforts; and conducting research and evaluations
to increase the knowledge base about effective APS programming and practices. Finally, +$3.6 million is
requested for two cross-cutting programs—Lifespan Respite Care and Aging and Disability Resource
Centers—to further develop more efficient, cost-effective and consumer responsive State-wide systems that
support both seniors and those of all ages with disabilities, and their families and caregivers.

The FY 2017 request also incorporates a new proposal to use up to 1% of the funds appropriated to ACL’s
nutrition programs to develop innovative, evidence-based practices for senior nutrition. Examples of
promising practices that enhance the quality and effectiveness of our nutrition program include service
products that appeal to caregivers (such as web-based ordering systems and carryout meals), increased
involvement of volunteers (such as retired chefs), new service models (testing variations and hybrid
strategies) and other innovations to better serve older adults. These funds may be used to help develop and
test additional models or to replicate models that have already been tested in other community-based
settings.

Finally, ACL continues to work towards the seamless integration of its recently transferred programs—
including Traumatic Brain Injury, Limb Loss, and those programs transferred by the 2014 Workforce
Innovation and Opportunity Act—having brought them all together under one roof in our recent move to the
Mary E. Switzer building. These programs closely align with ACL’s vision that all people, regardless of age
and disability, live with dignity, make their own choices, and participate fully in society. The transfer of
these programs is a significant step in the evolution of ACL. ACL’s past few years have been a time of
growth, learning, and a rededication of our efforts to ensure that all people, regardless of age or disability,
can live and thrive in their communities. This budget will allow us to continue serving our populations and
position us for greater successes on their behalf.

Kathy Greenlee
Administrator and Assistant Secretary for Aging
i
Table of Contents
Executive Summary
Introduction and Mission ................................................................................................................ 1
Overview of Budget Request .......................................................................................................... 3
Overview of Performance ............................................................................................................... 9
Appropriations Language .............................................................................................................. 19
Appropriations Language Analysis ............................................................................................... 21
Amounts Available for Obligation................................................................................................ 22
Summary of Changes .................................................................................................................... 23
Budget Authority by Activity ....................................................................................................... 24
Authorizing Legislation ................................................................................................................ 26
Appropriations History Table ....................................................................................................... 28
Appropriations Not Authorized by Law ....................................................................................... 29

Health and Independence for Older Adults
Summary of Request ..................................................................................................................... 31
Home and Community-Based Supportive Services ...................................................................... 35
Nutrition Services ......................................................................................................................... 45
Preventive Health Services ........................................................................................................... 61
Chronic Disease Self-Management Education ............................................................................. 69
Falls Prevention ............................................................................................................................ 75
Native American Nutrition and Supportive Services.................................................................... 81
Aging Network Support Activities ............................................................................................... 87

Caregiver and Family Support Services
Summary of Request ..................................................................................................................... 95
Family Caregiver Support Services .............................................................................................. 99
Native American Caregiver Support Services ............................................................................ 107
Alzheimer’s Disease Supportive Services Program ................................................................... 111
Alzheimer’s Disease Initiative - Specialized Supportive Services ............................................. 117
Lifespan Respite Care ................................................................................................................. 121

Protection of Vulnerable Adults
Summary of Request ................................................................................................................... 129
Long-Term Care Ombudsman Program ..................................................................................... 131
Prevention of Elder Abuse and Neglect ...................................................................................... 139
ii
Senior Medicare Patrol Program ................................................................................................. 145
Elder Rights Support Activities .................................................................................................. 151

Disability Programs, Research and Services
Summary of Request ................................................................................................................... 159
State Councils on Developmental Disabilities ............................................................................ 161
Developmental Disabilities – Protection and Advocacy ............................................................ 171
University Centers for Excellence in Developmental Disabilities ............................................. 179
Developmental Disabilities – Projects of National Significance ................................................ 187
National Institute on Disability, Independent Living, and Rehabilitation Research .................. 193
Independent Living ..................................................................................................................... 201
Limb Loss Resource Center ........................................................................................................ 209
Paralysis Resource Center ........................................................................................................... 213
Traumatic Brain Injury ............................................................................................................... 217

Consumer Information, Access & Outreach
Summary of Request ................................................................................................................... 225
Aging and Disability Resource Centers ...................................................................................... 227
State Health Insurance Assistance Programs .............................................................................. 233
Voting Access for Individuals with Disabilities ......................................................................... 239
Assistive Technology .................................................................................................................. 245
Alzheimer’s Disease Initiative - Outreach Campaign ................................................................ 256

Program Administration .......................................................................................................... 261

Supplementary Tables
Object Classification Table - Direct ........................................................................................... 267
Salaries and Expenses ................................................................................................................. 268
Detail of Full-Time Equivalent Employment (FTE) .................................................................. 269
Detail of Positions ....................................................................................................................... 270
Programs Proposed for Elimination ............................................................................................ 271
FTE Funded by the Affordable Care Act .................................................................................... 272
Physicians’ Comparability Allowance Worksheet ..................................................................... 273

Significant Items in Appropriations Committee Reports ..................................................... 275

Prevention and Public Health Fund ........................................................................................ 281
iii
This page intentionally left blank.
iv
v
This page intentionally left blank.
Introduction and Mission

The Administration for Community Living (ACL) works with states, localities, tribal
organizations, nonprofit organizations, businesses, and families to help older adults and people
with disabilities live independently and fully participate in their communities. ACL’s mission is
to maximize the independence, well-being, and health of older adults, people with disabilities
across the lifespan, and their families and caregivers. Those with disabilities or functional
limitations of any type, regardless of age, have a common interest: access to home and
community-based supports and services that can help individuals to fully participate in all
aspects of society, including having the option to live at home, which can be vital to an
individual’s well-being, instead of moving into an institutional setting. ACL works to improve
this access through program lines that address the unique needs of each population.

ACL’s programs provide community-based services and supports that help people to remain
independent while reducing costs to other public programs such as Medicaid. This is critical
given the growth in the segments of the population that these programs serve:

• The U.S. population over age 60 is projected to increase by 20 percent between 2014 and
2020, from 64.8 million to 77.6 million.1

• According to the U.S. Census Bureau, in 2010, there were 56.7 million Americans living
with disabilities, of which over 12 million required assistance with activities of daily
living or instrumental activities of daily living.2

• Studies indicate that individuals with developmental disabilities comprise between 1.2
and 1.65 percent of the U.S. population, or between 3.8 and 5.3 million individuals.3

• The number of seniors age 65 and older with severe disabilities – defined as 3 or more
limitations in activities of daily living – that are at greatest risk of nursing home
admission, is projected to increase by more than 20 percent by the year 2020. 4

1 U.S. Census Bureau, “2014 National Population Projections,” Table 1. Projected Population by Single Year of
Age, Sex, Race, and Hispanic Origin for the United States: 2014 to 2060. Released December 2014,
http://www.census.gov/population/projections/data/national/2014/downloadablefiles.html. Accessed 08 January
2015.
2 U.S. Census Bureau, “Americans With Disabilities: 2010,” http://www.census.gov/prod/2012pubs/p70-131.pdf,
Issued July 2012, Accessed 21 August 2014.
3 Extrapolated from Developmental Disabilities Assistance and Bill of Rights Act of 2000, Section 101(a)(1) (see
http://www.acl.gov/Programs/AIDD/DDA BOR ACT 2000/p2 tI subtitleA.aspx) and census estimates of U.S.
Population, July 1, 2014
1
EXECUTIVE SUMMARY

Meeting the long-term support needs of these populations can place tremendous strain on
families, and if families become overwhelmed by the challenges of caregiving, the costs of
providing this care will fall on other, more costly, government resources. For example, a 2014
Rand Corporation study found that the care provided by informal (family and friend) caregivers
of elderly adults has an estimated economic value of $522 billion.5 Maintaining funding for
community-based services and supports, including supports for family caregivers, is therefore
critical to delaying, reducing, or eliminating reliance upon institutional residential services, a
more expensive and less preferable option.

4 Ibid and Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare
population. Data from the 2013 Medicare Current Beneficiary Survey. [data tables 2.5a and 2.6a].
http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2013CNP.html
Accessed 10 January, 2016.
5 The Opportunity Costs of Informal Elder-Care in the United States. Rand Corporation.
http://www.rand.org/pubs/external_publications/EP66196.html.
2